Management for dental pulpitis is the excavation of the tooth decay with restoration (filling). If the pulpitis becomes irreversible then pulpectomy (pulp removal) and root canal treatment will be required. Acute spreading infection may require additional drainage intra or extra orally via drainage of involved tissue spaces.
Apical pain can be caused by infection spreading through the apical foramen of the tooth into the apical periodontal region causing inflammation (apical periodontitis) and ultimately a dental abscess if left untreated. This is treated by either root canal treatment of the tooth or extraction of the tooth with or without concomitant courses of antibiotics7. Iatrogenic apical pain may result after dental treatment including premature contact if a restoration is left high in occlusion. This is characterized by an initial sharp pain which becomes duller after a period. The pain is due to a recent tooth restoration that is ‘high’ compared with the normal occlusion when biting together and
Post endodontic surgery pain
This is severe aching pain following endodontic treatment such as root canal therapy or apicectomy. While the majority of patients improve over time (weeks), a few will develop a chronic neuropathic pain state. There is considerable variation in the pain reported by patients, but it commonly starts as a sharp stabbing pain that becomes progressively dull and throbbing. At first, the pain may be caused by a stimulus, but it then becomes spontaneous and remains for a considerable time after removal of the stimulus. The pain may radiate and be referred to other areas of the mouth. This type of pain tends to cause the patient to have difficulty sleeping and may be exacerbated by lying down. Heat may make the pain worse whereas cold may alleviate it. The pain may be intermittent with no regular pattern and may have occurred over months or years. If there is a periapical infection present, patients may no longer complain of pain in response to a thermal stimulus, but rather of sensitivity on biting.
Exposed cementum or dentine
There is tooth sensitivity from cold fluids and/or air, a reflection of a healthy pulp. With the gingival recession, recent scaling, or tooth wear due to a high acid diet or gastric reflux, there may be generalized dentine sensitivity. However, with caries, fractured fillings, and cracked cusps, the pain tends to be localized to the affected tooth. The tooth root surface comprises of a thin layer of cementum overlaying dentine, which may be exposed from excessive and/or incorrect tooth brushing. Dentine underlying the enamel crown is constituted of tiny tubules that are fluid-filled and connect directly to the nerve ending in the dental pulp. The current hypotheses for dental pain include the osmolality theory, whereby the dentine fluids elicit an action potential within the A-delta and C fibres in the pulp when stimulated by mechanical stimulation.